The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation

• Published in: World neurosurgery 2018-08, Vol.116, p.e225-e231
• Main Authors: Segal, Dale N., Wilson, Jacob M., Staley, Christopher, Michael, Keith W.
• Format: Article
• Language: English
• Subjects: 5-item modified frailty index; Complications; Kyphoplasty; Modified frailty index; NSQIP
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.04.172

Vertebral compression fractures are the most common spine injury seen in elderly patients. Vertebral augmentation is considered a safe and effective treatment. The ability to predict outcomes based on comorbidities is lacking. The modified frailty index has been used to predict complications after orthopedic and surgical procedures. We hypothesized that despite a low rate of adverse outcomes, postoperative complications after kyphoplasty would be greater in patients who are frail. The National Surgical Quality Improvement Program database was queried for patients who underwent kyphoplasty between 2006 and 2015. Complication data including 30-day complications, life-threatening complications, reoperation and readmission rate, and length of stay data was recorded, and 5-item modified frailty index (5i-mFI) scores were calculated. Univariate and multivariate logistic regression analyses were then conducted to analyze frailty as a predictor of postoperative complications after kyphoplasty. In total, 2465 patients were identified (mean age = 73.98). As 5i-mFI increased from 0 to ≥2, the rate of overall complications increased nearly 3-fold from 3.7% to 10.4% (P < 0.001) and the rate of life-threatening complications increased from 0.8% to 2.4% (P = 0.042). In addition, 30-day readmission increased from 8.9% to 12.9% (P = 0.005), adverse hospital discharge increased from 7.6% to 25.6% (P < 0.001), and length of stay increased from 1.66 days to 3.75 days (P < 0.001). Frailty was associated with increased total complications, Clavien–Dindo IV complications, length of stay, and 30-day readmission rates. The 5i-mFI is a straightforward assessment tool that correlates with outcomes after kyphoplasty. It can be used to help clinicians predict adverse events and facilitate informed discussions with their patients. •The 5i-mFI is a straightforward assessment tool that correlates with outcomes after kyphoplasty.•The overall complication rate in our cohort of 2465 patients was 6.6%, is consistent with that reported in the literature.•The complication rate increased nearly 3-fold between patients with an mFI of 0 and those with a 5i-mFI of ≥2.•Frailty was associated with greater rates of overall and life-threatening complications, increased LOS, and readmission.